Long live independent rad onc....

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emt409

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Some of you know I may not be the most popular rad onc on SDN, but I care about our field, I love radiosurgery, I care about my patients, and I care about delivering what I believe the possible treatment there is.

I couldn't do it in an ivory tower, so I'm gonna at least try it in better weather.

Ohio winters really suck.

Wish me luck! Don't judge me too hard- I'm not that great at website building.

therenaissanceinstitute.org

The Renaissance Institute of Precision Oncology & Radiosurgery

Learn about our advanced stereotactic radiosurgery treatment for brain tumors, malignant & benign. Contact us for a consultation today.
therenaissanceinstitute.org therenaissanceinstitute.org

x.com

x.com x.com
Members don't see this ad.
 
emt409 said:
Some of you know I may not be the most popular rad onc on SDN, but I care about our field, I love radiosurgery, I care about my patients, and I care about delivering what I believe the possible treatment there is.

I couldn't do it in an ivory tower, so I'm gonna at least try it in better weather.

Ohio winters really suck.

Wish me luck! Don't judge me too hard- I'm not that great at website building.

therenaissanceinstitute.org

The Renaissance Institute of Precision Oncology & Radiosurgery

Learn about our advanced stereotactic radiosurgery treatment for brain tumors, malignant & benign. Contact us for a consultation today.
therenaissanceinstitute.org therenaissanceinstitute.org

x.com

x.com x.com
Click to expand...
That's awesome, esp. all that benign stuff! Best of luck to you sir.
 
Members don't see this ad :)
good luck man!
we don't see docs do this often due to high capital costs
i wish you the best and hope you do great
 
Lovely, good luck!

On a side note:
The website lists the complicated radiosurgery treatments you offer, but you also have a Halcyon?
That's probably for the prostates of Florida?
 
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emt409 said:
Some of you know I may not be the most popular rad onc on SDN, but I care about our field, I love radiosurgery, I care about my patients, and I care about delivering what I believe the possible treatment there is.

I couldn't do it in an ivory tower, so I'm gonna at least try it in better weather.

Ohio winters really suck.

Wish me luck! Don't judge me too hard- I'm not that great at website building.

therenaissanceinstitute.org

The Renaissance Institute of Precision Oncology & Radiosurgery

Learn about our advanced stereotactic radiosurgery treatment for brain tumors, malignant & benign. Contact us for a consultation today.
therenaissanceinstitute.org therenaissanceinstitute.org

x.com

x.com x.com
Click to expand...

This is awesome, was really happy to see it on the X. Good luck!

Good for you for ditching the ivory tower if they are holding you back. More ROs need to get comfortable doing that.
 
In theory, this sounds great. I’m not a fan of consolidation to the ivory towers and this does seem to offer some unique things. But what happens if the more non-traditional benign treatments don’t pay the bills?

While the ability to open this center is impressive and rare in our field, my initial reaction is that this is unnecessary and could become borderline sketchy. Opening up a private, specialty, “radiosurgery” center in one of the most over-saturated areas of the country reminds of the “radiosurgery” center in New York that made very questionable medical and ethical decisions. Please don’t go that direction.

Our field really does have a problem with eating our own and chastising our colleagues, so apologies that I am the Debbie Downer.
I hope this works and leads to benign treatments being widely adopted all over the country, but color me skeptical. The website looks good.
 
While the ability to open this center is impressive and rare in our field, my initial reaction is that this is unnecessary and could become borderline sketchy. Opening up a private, specialty, “radiosurgery” center in one of the most over-saturated areas of the country reminds of the “radiosurgery” center in New York that made very questionable medical and ethical decisions.
Click to expand...
The counterargument is that more people will benefit from his expertise in Florida than in Ohio.
 
metallica81788 said:
In theory, this sounds great. I’m not a fan of consolidation to the ivory towers and this does seem to offer some unique things. But what happens if the more non-traditional benign treatments don’t pay the bills?

While the ability to open this center is impressive and rare in our field, my initial reaction is that this is unnecessary and could become borderline sketchy. Opening up a private, specialty, “radiosurgery” center in one of the most over-saturated areas of the country reminds of the “radiosurgery” center in New York that made very questionable medical and ethical decisions. Please don’t go that direction.

Our field really does have a problem with eating our own and chastising our colleagues, so apologies that I am the Debbie Downer.
I hope this works and leads to benign treatments being widely adopted all over the country, but color me skeptical. The website looks good.
Click to expand...
1730388652439.png


In all seriousness, would be cool if this works out.
 
Palex80 said:
The counterargument is that more people will benefit from his expertise in Florida than in Ohio.
Click to expand...

best of luck to Evan. however, trust me the patients of neither Florida or Ohio are missing opportunities to receive SRS. also Ohio State has a muchbigger catchment area than a free standing center - in terms of access to non-traditional applications of SRS. Evan would have to say more if there was an issue at Ohio State in terms of getting buy in from collaborators.
 
Members don't see this ad :)
I hope people apply these concerns to academic centers because I basically never see it outside of occasional comments on this message board.

"Benign RT" is just ramping up in the closed minds of mainstream US radiation oncology. Were just getting started.

If radiation for spasticity is successful for example, you better believe you will see MSKCC advertising their telemedicine service in Florida, implying they do it better than X independent center, and potentially with $500 per patient from ROCR to subsidize their travel.
 
BobbyHeenan said:
I think this is cool.

I bet more than "buy in" from referrals, your best bet for success is figuring out how to get to the top of the google search algorithm for the conditions you treat.
Click to expand...
This would be a great thing for Dr. Elon Musk, a wealthy rad onc who's passionate about radiosurgery, to attempt to do. Undeniably a great service to society and a clinic that is "needed."

However, if you do not have money to burn, this project faces considerable headwinds. Back of envelope calcs tell me this center needs bare minimum 150 new SRS or SBRT patients per year (I have guessed $5-10M to get this place up and running and a $3M per year overhead, including physician salaries). Further envelopical calculations tell me that this is roughly 6x the average annual SRS/SBRT patient workload per individual rad onc (e.g., the average rad onc resident graduates having done ~15 SRS/SBRT cases per year of training). In the beginning, this center will need to drink other centers' milkshakes versus hoping to create new milkshake recipes of its own.

This center will wind up needing to treat many other things besides just SRS/SBRT (and current accepted indications therefrom) to have going concern.* Top of Google search algorithm for SRS/SBRT will not be the best bet for success. IMHO. The rising tide of needs-preauth'd Medicare Advantage patients in FL would worry me too. The pure Medicare-only old days were good/better for new rad onc centers.

*or have industry support
 
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radoncftw said:
I realize after reading the X post this is a joint venture with support from Varian and Siemens
Could move to business forum, but curious how you were able to do this financially (or what you had to contribute from a financial standpoint).
Click to expand...
I don't know the first thing about opening a new center in Florida and even less about collaborating with the likes of Varian/Siemens. However, I would humbly suggest looking around before starting contouring to avoid an inadvertant HIPAA violation.
 
Good luck! But I would caution (not Evan) that this is the furthest thing from a typical independent private practice/community radonc gig/startup.

They are advertising very specialized treatments to benign conditions with sometimes difficult to ascertain literature (per my review) and outcomes.

This is an independent neurosurgical venture with industry backing. This is a radonc who is exceptionally well connected to industry apparently.

Maybe it should be considered an start-up research institute? Cause frankly, that's what it should be IMO. Industry should help them establish an IRB. Will they offer DBS as well or partner with a regional institution that offers other interventions for these said benign conditions?

The last thing we need is SRS hypophysectomy/thalamotomy/pallidotomy becoming SOC cause it's done somewhere, it's marketed well, there is industry backing and most people do OK. That's sort of like protons becoming SOC.
 
communitydoc13 said:
Good luck! But I would caution (not Evan) that this is the furthest thing from a typical independent private practice/community radonc gig/startup.

They are advertising very specialized treatments to benign conditions with sometimes difficult to ascertain literature (per my review) and outcomes.

This is an independent neurosurgical venture with industry backing. This is a radonc who is exceptionally well connected to industry apparently.

Maybe it should be considered an start-up research institute? Cause frankly, that's what it should be IMO. Industry should help them establish an IRB. Will they offer DBS as well or partner with a regional institution that offers other interventions for these said benign conditions?

The last thing we need is SRS hypophysectomy/thalamotomy/pallidotomy becoming SOC cause it's done somewhere, it's marketed well, there is industry backing and most people do OK. That's sort of like protons becoming SOC.
Click to expand...

We already have better data for SRS for those benign conditions than we do for protons though.
 
OTN said:
We already have better data for SRS for those benign conditions than we do for protons though.
Click to expand...
The concern is SRS relative to other interventions not protons. The proton reference was just to point out how an unproven intervention became a de-facto SOC due to marketing/investment/industry backing and a "just do it" mentality without good comparative research.
 
metallica81788 said:
Our field really does have a problem with eating our own and chastising our colleagues
Click to expand...

With too many rad onc’s and centers, only way to get fed is to eat someone else’s lunch.

One day insurance companies will wake up and realize they’re overpaying for NCCN centers and their satellites, they’ll fund independent rad onc/freestanding centers and funnel patients to them (this is legal for insurers to do), and NCCN centers will cry in a corner.

For now, big insurers like United and Elevance will continue to overpay for protons.

Anyways, this joint venture with industry funding is great to see. Hope Renaissance crushes it!
 
yesmaster said:
, they’ll fund independent rad onc/freestanding centers and funnel patients to them (this is legal for insurers to do), and NCCN centers will cry in a corner.
Click to expand...
Some insurers let pts pay lower copays at these facilities as well. Some of the cheaper MA plans save money exactly by not contracting with more expensive PPS exempt/NCCN centers etc
 
metallica81788 said:
In theory, this sounds great. I’m not a fan of consolidation to the ivory towers and this does seem to offer some unique things. But what happens if the more non-traditional benign treatments don’t pay the bills?

While the ability to open this center is impressive and rare in our field, my initial reaction is that this is unnecessary and could become borderline sketchy. Opening up a private, specialty, “radiosurgery” center in one of the most over-saturated areas of the country reminds of the “radiosurgery” center in New York that made very questionable medical and ethical decisions. Please don’t go that direction.

Our field really does have a problem with eating our own and chastising our colleagues, so apologies that I am the Debbie Downer.
I hope this works and leads to benign treatments being widely adopted all over the country, but color me skeptical. The website looks good.
Click to expand...

What’s the New York radiosurgery story?
 
metallica81788 said:
In theory, this sounds great. I’m not a fan of consolidation to the ivory towers and this does seem to offer some unique things. But what happens if the more non-traditional benign treatments don’t pay the bills?

While the ability to open this center is impressive and rare in our field, my initial reaction is that this is unnecessary and could become borderline sketchy. Opening up a private, specialty, “radiosurgery” center in one of the most over-saturated areas of the country reminds of the “radiosurgery” center in New York that made very questionable medical and ethical decisions. Please don’t go that direction.

Our field really does have a problem with eating our own and chastising our colleagues, so apologies that I am the Debbie Downer.
I hope this works and leads to benign treatments being widely adopted all over the country, but color me skeptical. The website looks good.
Click to expand...
Just the essential & Parkinson's tremor market is huge and untapped. The pain market is big too. Worked with Varian over the last several years to help get 510k approval. The numbers look even better if you and a partner keep the NS professional codes in house.

The Florida market is super-saturated, but not with quality.

Palex80 said:
View attachment 394401
Click to expand...
haha - don't worry, there's always proton cordotomy- i haven't been able to make the dosimetry work for GK or linac yet
 
communitydoc13 said:
Good luck! But I would caution (not Evan) that this is the furthest thing from a typical independent private practice/community radonc gig/startup.

They are advertising very specialized treatments to benign conditions with sometimes difficult to ascertain literature (per my review) and outcomes.

This is an independent neurosurgical venture with industry backing. This is a radonc who is exceptionally well connected to industry apparently.

Maybe it should be considered an start-up research institute? Cause frankly, that's what it should be IMO. Industry should help them establish an IRB. Will they offer DBS as well or partner with a regional institution that offers other interventions for these said benign conditions?

The last thing we need is SRS hypophysectomy/thalamotomy/pallidotomy becoming SOC cause it's done somewhere, it's marketed well, there is industry backing and most people do OK. That's sort of like protons becoming SOC.
Click to expand...

Funny you mention! I did start a sister 501c3 to run the research & philanthrophy arm out of. We already have some donations for a dystonia trial. If you need a quick tax write-off, hit me up! 🙂

We are working on a contract with a private IRB. It's more expensive than I thought.

And agree that it's probably not the best idea for median thalamotomies, bilateral capsulotomies, and hypophysectomies to be springing up everywhere. But these are adjunctive treatments for the worst of the worst, and don't really compete against any standard of care of treatments. (like proton eating IMRT). I think (and hope) that there is room for a few more of these centers in select markets because there are a lot of patients in need.
 
thesauce said:
What’s the New York radiosurgery story?
Click to expand...
Not sure. On an unrelated note did you hear about this news story from 2004?

BEATLE GUITAR DOCTOR BOOTED

A top cancer doctor is out as director of radiation oncology at a Staten Island hospital amid shocking allegations he forced George Harrison to sign a guitar as the Beatle lay dying. Dr. Gil Lederm…
nypost.com nypost.com
 
brushbeamscanning said:
Not sure. On an unrelated note did you hear about this news story from 2004?

BEATLE GUITAR DOCTOR BOOTED

A top cancer doctor is out as director of radiation oncology at a Staten Island hospital amid shocking allegations he forced George Harrison to sign a guitar as the Beatle lay dying. Dr. Gil Lederm…
nypost.com nypost.com
Click to expand...
That's the guy! (Radiosurgery New York)

nymag.com

Gil Lederman's Dubious Career - Nymag

When the notorious cancer doctor Gil Lederman cadged an autograph from a dying George Harrison, the world was appalled.But as Lederman scrambles to salvage his reputation, the very nature of his experimental practice has come under attack.
nymag.com nymag.com
 
emt409 said:
Funny you mention! I did start a sister 501c3 to run the research & philanthrophy arm out of. We already have some donations for a dystonia trial. If you need a quick tax write-off, hit me up! 🙂

We are working on a contract with a private IRB. It's more expensive than I thought.

And agree that it's probably not the best idea for median thalamotomies, bilateral capsulotomies, and hypophysectomies to be springing up everywhere. But these are adjunctive treatments for the worst of the worst, and don't really compete against any standard of care of treatments. (like proton eating IMRT). I think (and hope) that there is room for a few more of these centers in select markets because there are a lot of patients in need.
Click to expand...

I agree you have tons of potential with this center
 
brushbeamscanning said:
Not sure. On an unrelated note did you hear about this news story from 2004?

BEATLE GUITAR DOCTOR BOOTED

A top cancer doctor is out as director of radiation oncology at a Staten Island hospital amid shocking allegations he forced George Harrison to sign a guitar as the Beatle lay dying. Dr. Gil Lederm…
nypost.com nypost.com
Click to expand...
Someone broke HIPPA too once he got treated for brain Mets. I can’t remember who right off hand, but it was a pretty gross violation.
 
emt409 said:
But these are adjunctive treatments for the worst of the worst, and don't really compete against any standard of care of treatments. (like proton eating IMRT). I think (and hope) that there is room for a few more of these centers in select markets because there are a lot of patients in need.
Click to expand...
This is where how you practice will have such a big impact on your legacy.

If you put forward the resources (or better yet, convinced a third party to do so), run this practice from a business plan and market directly to desperate patients, you will (contingent on demographics/payors) make a sh!% ton of money...and no one will know if you did good by your patients in aggregate (sort of like chiropractic). These are conditions where subjective outcomes are important and are hard to measure. I have no doubt that you will have patients thanking you for your care.

But...this is much more dangerous tool than a set of hands (not entirely benign either). It also is high cost. 4% significant toxicity in the brain is serious. This is not 3 Gy over 6 fractions to a joint with a complex plan.

It would be nice if you found a way to contribute scientifically from an independent practice if you are taking on cases like this.

Curious as to why you couldn't carve out a practice directed at indications like this at a place like the James?
 
communitydoc13 said:
This is where how you practice will have such a big impact on your legacy.

If you put forward the resources (or better yet, convinced a third party to do so), run this practice from a business plan and market directly to desperate patients, you will (contingent on demographics/payors) make a sh!% ton of money...and no one will know if you did good by your patients in aggregate (sort of like chiropractic). These are conditions where subjective outcomes are important and are hard to measure. I have no doubt that you will have patients thanking you for your care.

But...this is much more dangerous tool than a set of hands (not entirely benign either). It also is high cost. 4% significant toxicity in the brain is serious. This is not 3 Gy over 6 fractions to a joint with a complex plan.

It would be nice if you found a way to contribute scientifically from an independent practice if you are taking on cases like this.

Curious as to why you couldn't carve out a practice directed at indications like this at a place like the James?
Click to expand...

He said he’s working with an independent IRB. Presumably this is for research.

He probably could’ve done it in Columbus, but always better to be your own boss. Big admin just screws everything up.
 
thesauce said:
He probably could’ve done it in Columbus, but always better to be your own boss. Big admin just screws everything up.
Click to expand...
No.

Big admin screws many things up. Big institutions rarely act ethically. But academics in aggregate are kind of a remarkable thing and do function to mitigate the contaminating personal financial motivations that exist in the private sector. They also mitigate personal grandiosity (exempting chairs and CEOs). I think Evan is trying to do a remarkable thing. There are advantages to going alone...and significant risks...and significant skepticism that consumers of science should have regarding science that is basically coming from the corporate sector.

Is Kevin Murphy doing big science or just confusing things? I'm not sure.
 
communitydoc13 said:
No.

Big admin screws many things up. Big institutions rarely act ethically. But academics in aggregate are kind of a remarkable thing and do function to mitigate the contaminating personal financial motivations that exist in the private sector.
Click to expand...
Big Rad Onc, big protons, big PPS exempt

Nancy Lee's tweet from years ago on continuing to treat with protons without supporting data is non-mitigation 101

Agree to disagree
 
Last edited:
communitydoc13 said:
No.

Big admin screws many things up. Big institutions rarely act ethically. But academics in aggregate are kind of a remarkable thing and do function to mitigate the contaminating personal financial motivations that exist in the private sector. They also mitigate personal grandiosity (exempting chairs and CEOs). I think Evan is trying to do a remarkable thing. There are advantages to going alone...and significant risks...and significant skepticism that consumers of science should have regarding science that is basically coming from the corporate sector.

Is Kevin Murphy doing big science or just confusing things? I'm not sure.
Click to expand...

I also disagree - the egos I have seen coming from academicians (not just chairs) have been incredible. I would never say "I'm the best radonc in the world at treating x disease" but I have heard it from several academicians over the years. Super cringe.

Additionally, they've done precisely the opposite of mitigating financial motivations, as their institutions constitute some of the best examples of regulatory capture leading to a fleecing of consumers that we have in the modern world.
 
OTN said:
I also disagree - the egos I have seen coming from academicians (not just chairs) have been incredible. I would never say "I'm the best radonc in the world at treating x disease" but I have heard it from several academicians over the years. Super cringe.

Additionally, they've done precisely the opposite of mitigating financial motivations, as their institutions constitute some of the best examples of regulatory capture leading to a fleecing of consumers that we have in the modern world.
Click to expand...
All good points...except their financial toxicity is different (and more effective) than most private places. It rarely goes directly to the docs, although the cost to society can be huge.

Agree that many academics can believe that their institutional brand reflects personal excellence...of course this is a mistake...and the OP will now have forsaken that sort of brand affiliation (exempting industry branding I guess)?

But, while the OP is uniquely equipped for this sort of venture, he also fairly uniquely equipped to do certain types of research. It's just not a typical community care space. Hoping for the best.
 
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communitydoc13 said:
Good luck! But I would caution (not Evan) that this is the furthest thing from a typical independent private practice/community radonc gig/startup.

They are advertising very specialized treatments to benign conditions with sometimes difficult to ascertain literature (per my review) and outcomes.

This is an independent neurosurgical venture with industry backing. This is a radonc who is exceptionally well connected to industry apparently.

Maybe it should be considered an start-up research institute? Cause frankly, that's what it should be IMO. Industry should help them establish an IRB. Will they offer DBS as well or partner with a regional institution that offers other interventions for these said benign conditions?

The last thing we need is SRS hypophysectomy/thalamotomy/pallidotomy becoming SOC cause it's done somewhere, it's marketed well, there is industry backing and most people do OK. That's sort of like protons becoming SOC.
Click to expand...
If you need a good independent IRB to help with clinical trials, WCG (Wirb Copernicus Group near Seattle) is excellent; very efficient and although they charge for protocol approvals, etc, that your university won't bill you for, they can turn things around in days/weeks instead of months/years.

I have no ties except having used them before.
 
emt409 said:
Just the essential & Parkinson's tremor market is huge and untapped. The pain market is big too. Worked with Varian over the last several years to help get 510k approval. The numbers look even better if you and a partner keep the NS professional codes in house.
Click to expand...

Are you planning any PD research? Id love to donate.
 
communitydoc13 said:
No.

Big admin screws many things up. Big institutions rarely act ethically. But academics in aggregate are kind of a remarkable thing and do function to mitigate the contaminating personal financial motivations that exist in the private sector. They also mitigate personal grandiosity (exempting chairs and CEOs). I think Evan is trying to do a remarkable thing. There are advantages to going alone...and significant risks...and significant skepticism that consumers of science should have regarding science that is basically coming from the corporate sector.

Is Kevin Murphy doing big science or just confusing things? I'm not sure.
Click to expand...

Tell me you’re in academics without telling me you’re in academics.

I used to believe what you’re saying.

It would be very difficult for a private practice to drive up cost anywhere close to what an academic center is charging. Yes, the doctor won’t benefit from it but it’ll be a much higher cost to society.

If you truly think academics is any better at performing clinical studies, I would point to the rampant non-inferiority hypofractionation studies that are negative, but they still claim they’re successful. Even if they were positive, there is very little intellectual horsepower inherent to these trials. You could literally copy and paste the background and conclusions sections from one trial to the other.
 
thesauce said:
Tell me you’re in academics without telling me you’re in academics.

I used to believe what you’re saying.

It would be very difficult for a private practice to drive up cost anywhere close to what an academic center is charging. Yes, the doctor won’t benefit from it but it’ll be a much higher cost to society.

If you truly think academics is any better at performing clinical studies, I would point to the rampant non-inferiority hypofractionation studies that are negative, but they still claim they’re successful. Even if they were positive, there is very little intellectual horsepower inherent to these trials. You could literally copy and paste the background and conclusions sections from one trial to the other.
Click to expand...
I assure you, I am not in academics.

All of your critique is correct IMO. Particularly with regard to driving up cost. In our field, we have witnessed a glut of academic work that is marginally significant from a clinical perspective and requires very little imagination.

It is also true that the bulk of foundational work that has led to remarkable improvements in cancer outcomes over the past decade has been done in the academic setting, often with industry collusion.

For me the concerns regarding this particular project are:

1. Are they offering interventions that are still roughly considered experimental (supported by a few relatively small series of patients, typically treated at large institutions, never with meaningful comparison arms)?
2. Does their business model include direct to patient advertising for said experimental procedures? Will their advertising adequately disclose the experimental nature of their interventions?
3. Will they do the due diligence to explain the experimental nature of their interventions and to further the science regarding their interventions by publication, disclosure and preferably prospective clinical trials.

I have always viewed academic medicine as the place to offer and explore experimental therapies. I have abhorred the expansion of large academic centers to be providers of established SOC treatments with a mark-up in cost due to brand and institutional leverage.

I am not yet comfortable in general with private practice as the place to explore experimental care in general. If this is done well, I could change my mind.
 
communitydoc13 said:
But academics in aggregate are kind of a remarkable thing and do function to mitigate the contaminating personal financial motivations that exist in the private sector. They also mitigate personal grandiosity (exempting chairs and CEOs).
Click to expand...

Haha that has definitely not been my experience, but the milage really does vary. So institution dependent.

I also think there are fewer and fewer differences between a large non-academic network and an academic network these days.
 
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